Through the Times With Peter Kramer, M.D.

When he first entered psychoanalysis as a patient, this 22-year-old Marshall scholar envisaged his future as that of a melancholic, isolated writer. Instead, he uncovered a repressed desire to become a psychiatrist. Through the years, Peter Kramer, M.D., has interwoven the two careers of writer and clinical psychiatrist and followed a life path that he has described as "up from melancholy."

In 1970, Kramer had graduated from Harvard College with high honors in history and literature and was attending University College in London on a postgraduate scholarship, yet he was uneasy. "I was someone who was very interested in literature and philosophy," Kramer told Psychiatric Times. But that was during the Vietnam War years, and many young Americans felt the imperative toward relevance, service and practical good.

Partly because of his need to feel relevant and partly because of his lack of pleasure in his own academic successes, he entered psychoanalysis at Hampstead Clinic, the Freudian epicenter in Great Britain. "In the course of being an analytic patient, I came to the realization that I had in some ways always wanted to be a doctor but had set that goal aside. In particular, I wanted to be a psychoanalyst," Kramer added. In Kramer's newest book, Against Depression (New York: Viking, 2005), he writes of those life-transforming years:

When I announced that I wanted to enter medical school and become a psychiatrist, my analyst did not discourage me ... My analyst wanted me to understand that the wish, from childhood, to protect my relatives--the need to ward off depression and to conquer disease--was shaping my career choice ... I do not deny that my attitudes toward mood disorder have deep roots.

Born in New York City just after World War II, Kramer grew up in the shadow of the Holocaust. He wrote in Against Depression:

All my relatives were German Jews. Those few who had managed to get out--they included my parents, my grandparents and one great-grandmother--had done so at the last possible moment. Most other family members were killed or died of medical neglect.

Disease also marked the family. In the first four years of Kramer's life, his father, a pharmacist, was hospitalized twice with tuberculosis.

While in London and in the summers back in the United States, Kramer enrolled in the science courses that prepared him for medical school. In 1972, he entered Harvard Medical School and quickly began exploring the multiplicity of theories and models found within psychiatry.

"I started seeing psychiatric patients in my spare time, such as it was, from the first month I was in medical school at Harvard. I saw patients at Beth Israel Hospital, working mostly with Ted [Theodore] Nadelson, M.D.," he said. "By the time I had finished my undergraduate training, I had almost the equivalent of a residency in the model that Harvard used at that time, which was very Freudian." On a more informal basis, Kramer studied community psychiatry with Milton Mazer, M.D.; psychiatric theory with Leston Havens, M.D.; and social psychiatry with Robert Coles, M.D.

After Harvard, Kramer interned at the University of Wisconsin Hospital in Madison. Although he had a medical internship, he informally began studying group and family psychotherapy with James Gustafson, M.D., and Carl Whitaker, M.D.

When it came time for Kramer to do his psychiatric residency, Havens suggested that he experience an alternative to Harvard's psychoanalytic model by going to Yale University, which emphasized biological psychiatry and community mental health.

"Leston Havens was right to expose me to nonpsychoanalytic psychiatry. I think he saw a pragmatic streak in me. Although I considered myself to be intellectual, I was prone to a brusque practicality," Kramer said.

Havens encouraged taking a broad view of psychiatry. "Yale sent me in that direction," Kramer added, "as did my work in the government, where as a young man, I had oversight of a very broad research portfolio."

From 1980 to 1982, he worked as acting director of the Division of Science for the Alcohol, Drug Abuse, and Mental Health Administration and then as special assistant for science to the agency's administrator. Kramer often served as a liaison between the scientific community and members of Congress. During those same years, he became an instructor and then assistant clinical professor in the department of psychiatry at George Washington University in Washington, D.C. He also rose from assistant professor in 1982 to clinical professor in the department of psychiatry and human behavior at Brown University.

Psychiatric Times

Just after his residency, Kramer wrote a novel. Although the novel was never published, Kramer said it did help him become a columnist for PT.

"I was talking about it with Walter Reich, M.D., during one of the American Psychiatric [Association] meetings in Dallas, and John Schwartz [M.D.] came up to him and asked if he would want to review a book. Walter said 'No, but Peter should, since he had just written a novel.' So John asked me to send him the novel, and he'd look at it. He also asked me to review a book by Samuel Shem [pseudonym for Stephen Bergman, M.D.], and I did."

The book review appeared in PT in August of 1985. Schwartz then asked Kramer to review another book, but he had other ideas. He blurted out, "No, I am not going to write a book review; I'm going to write a column for you." The first "Practicing" column, titled "Limits of Power," appeared on the front page of PT in October of 1985. It discussed a patient Kramer knew of who believed that psychotherapy was going to save his life in the face of cancer, but who subsequently died. "I questioned how magical we want psychotherapy to be," Kramer said.

In an act of chutzpah, Kramer then called Schwartz and said that the column should not be on page 1, but rather on page 2 or 3 every month. Schwartz responded that he had a pharmacology column on page 3. Kramer was undeterred: "I said something that I have never again said in my life, and I don't know where the confidence came from. 'Anybody can have a pharmacology column,' I said. 'Nobody has what I am going to write for you.' I took over page 3 and was there every month for 10 years."